Gram stain to the rescue: a case report of cerebral phaeohyphomycosis by Cladophialophora bantiana in an immunocompetent 24-year-old

BMC Infectious Diseases

Paul Wada¹  Katie D. White¹  Karen C. Bloch¹  Alexander S. Maris²  Romney Humphries²  Tonya Snyder²  Jennifer Steinhauer²  Perceus Mody²  Michail S. Lionakis³ 

[1] Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA;Department of Pathology, Immunology and Microbiology, Vanderbilt University Medical Center, 1301 Medical Center Dr., TVC 4524, 37232, Nashville, TN, USA;Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Annapolis, MD, USA;Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Annapolis, MD, USA;

关键词: Cladophialophora bantiana;    Brain abscess;    Dematiaceous mold;    Melanized fungi;    Cerebral phaeohyphomycosis;    Case report;   

DOI  :  10.1186/s12879-021-07008-4

来源: Springer

【 摘 要 】

BackgroundFungal brain abscesses in immunocompetent patients are exceedingly rare. Cladophialophora bantiana is the most common cause of cerebral phaeohyphomycosis, a dematiaceous mold. Radiological presentation can mimic other disease states, with diagnosis through surgical aspiration and growth of melanized fungi in culture. Exposure is often unknown, with delayed presentation and diagnosis.Case presentationWe present a case of cerebral phaeohyphomycosis in a 24-year-old with no underlying conditions or risk factors for disease. He developed upper respiratory symptoms, fevers, and headaches over the course of 2 months. On admission, he underwent brain MRI which demonstrated three parietotemporal rim-enhancing lesions. Stereotactic aspiration revealed a dematiaceous mold on staining and the patient was treated with liposomal amphotericin B, 5-flucytosine, and posaconazole prior to culture confirmation. He ultimately required surgical excision of the brain abscesses and prolonged course of antifungal therapy, with clinical improvement.ConclusionsCulture remains the gold standard for diagnosis of infection. Distinct microbiologic findings can aid in identification and guide antimicrobial therapy. While little guidance exists on treatment, patients have had favorable outcomes with surgery and combination antifungal therapy. In improving awareness, clinicians may accurately diagnose disease and initiate appropriate therapy in a more timely manner.

【 授权许可】

CC BY